Provider Demographics
NPI:1154728806
Name:WAKEFIELD, KELSEY ANNE (ATC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ANNE
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S CONKLIN ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2320
Mailing Address - Country:US
Mailing Address - Phone:509-869-2199
Mailing Address - Fax:
Practice Address - Street 1:601 S CONKLIN ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2320
Practice Address - Country:US
Practice Address - Phone:509-869-2199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA20000055622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer